1951, 05-03 Permit App: 5383 Sewage DisposalTO 'd 1W01 -
SFUKANE WUN 1 Y HEAL! H UEPAli 1 MEN 1
Division of Sanitation q f g
1127 W. Mallon Avenue 61 -
Spokane 11, Washington N? 5383
-
DATE_
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACIUT1ES
AddressiCif, hone °Mg ifyg
• Site of ......
Maine C•42-4-711,
Address of Propos Site.
Type of Use--
..... -,..... Other__
Number of Bedrooms Y Building Capacity Camp Capacity _Other
IN property below grade of streets or alleys? Are streets graded in"
Is basement for building planned'
Water Supply
, e11, Spring).
Septic tank capacity 10/0 _gals. Style of tank.
Length of disposal
How Much excavation or fill proposed?
(1) Draw in property area to scale,
(2) Show relative locatioo of: Proposed house, septic tankiV.
disposal field, well, garage, and other out buildings_ r:
(a) Make note of any heavy slope or 'swampy area or any
X
other important topographic details.
Date when test hole will be ready for
Date installation will be ready for final inspection (that is,
before baokfilling)
_‘••••
NT`
7 ....
7 .-
SANITARIAN'S REPORT AND RECOMMENDATIONS:
Topography
Ground Water
Soil Condition
Special Recommendations
Date of Inspection_
Percolation tests: Minutes
••••••••••••••.............••••••••••••••••••••
Final Inspection Date
Remarks:
f
RECOMMENDED PERMIT BE_
Sanitarian
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